COLOSTOMY (Latin colon a colon + grech, stoma of companies, an opening, pass) — operation of formation of the outside specially imposed fistula of a large intestine — a kolostoma. Depending on department of a large intestine on which fistula is imposed it is necessary to distinguish tsekosty, astsendosty, transverzosty, destsendosty and sigmosty. Kolostoma can be trailer (single-barreled), pristenochny and double-barreled, temporary and constant. In domestic literature of a kolostoma it is accepted to call intestinal fistulas or (during the imposing of fistula on the left departments of a large intestine) an artificial anus.
Indications: the expressed disturbances of passability of a large intestine of organic character, not removable by a single-step resection with imposing of an anastomosis; creation of a decompression of a gut under unfavorable conditions for healing of the imposed anastomosis; neudalimy tumor and injury of a rectum.
It is preferable to perform operation under anesthetic. Access — median laparotomy (see). To. carry out after audit of an abdominal cavity. A gut remove through a special wound in side departments of a stomach, otstupya 3 — 4 cm from edge of an ileal bone with tselyo simplification of care of kolostomy. During the imposing pristenochny and double-barreled kolosty edges of a section of a peritoneum hem to edges of a skin wound, and then the same seams fix a wall of the removed gut on a circle. At a double-barreled kolostoma (transverzo-and a sigmostoma) the gut will be mobilized so that she was freely brought higher than the level of skin, and under it bring «spur». At such operations the gleam of a gut is usually opened not at once, and in 1 — 2 days.
Trailer (single-barreled) kolostoma impose in two essentially different ways. At a kolostoma in the form of a column remove the end of a gut considerably acting over the level of skin. Formation of a kolostoma proceeds slowly, with the expressed processes of a granulation, scarring and gradual epithelization. Such kolostoma is narrowed and deformed that can lead to the phenomena of intestinal impassability.
At a «flat» kolostoma (at the level of skin) walls of the removed gut are sewed directly with edge of a skin wound. Such kolostoma in the subsequent is not narrowed and well functions. This technique provides a separate podshivaniye of a peritoneum on a circle of a gut in an abdominal cavity without sewing together of a peritoneum with skin. Many surgeons at the same time with success carry out a gut to a skin wound via the channel under an otsloyenny peritoneum (retroperitoneal carrying out a gut). This way warns such complications To., as perikolostomichesky abscesses, immersion of a kolostoma in an abdominal cavity, a necrosis of the removed gut, etc.
Outcome operations depends on character and a current of a basic disease, apropos to-rogo the kolostoma is imposed.
Bibliography: Boguslavsky L. S. Technology of colostomy at the level of skin, Surgery, JVb 5, page 80, 1972; M e l N and-kov R. A., Bernstein M. I. and Simonov H. H. Our experience of treatment of oncological patients is more senior than 70 years, Vestn, hir., t. 111, No. 8, page 16, 1973; Red A. N. The atlas of operations on direct and thick guts, page 76, M., 1968; Modern stoma care, ed. by F. Page of Walker, Edinburgh — L., 1976.
V. D. Fedorov.